小剂量及短疗程质子泵抑制剂预防低危ESD术后出血的疗效研究

The efficacy of low-dose,short-term proton pump inhibitors in preventing postoperative bleeding of low-risk ESD

目的探讨小剂量、短疗程质子泵抑制剂预防低危内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)术后出血的疗效。方法选取2019年1月至2021年1月本院因早期胃癌或癌前病变行ESD治疗的160例患者作为研究对象,采用随机数字表法分为两组,每组80例。试验组男44例、女36例,年龄(59.78±5.76)岁;对照组男41例、女39例,年龄(60.21±6.05)岁。试验组患者ESD术后给予艾司奥美拉唑20 mg、2次/d静脉注射,3 d后改为口服制剂(艾司奥美拉唑镁肠溶胶囊,20 mg,1次/d),继续治疗4周;对照组患者ESD术后给予艾司奥美拉唑40 mg、2次/d静脉注射,3 d后改为口服制剂(艾司奥美拉唑镁肠溶胶囊,20 mg,2次/d),继续治疗8周。两组患者分别于ESD治疗后4周、8周行电子胃镜检查,以再生黏膜组织学成熟度评估溃疡愈合质量,并比较两组的术后出血率。结果术后4周,试验组再生黏膜组织学成熟度评价为优的占36.25%(29/80),显著高于对照组21.25%(17/80),差异有统计学意义(P<0.05);术后8周,试验组再生黏膜组织学成熟度评价为优的占53.75%(43/80),与对照组55.00%(44/80)比较,差异无统计学意义(P>0.05)。术后4周,试验组迟发性出血率为2.50%(2/80),显著低于对照组11.25%(9/80),差异有统计学意义(P<0.05);术后8周,两组患者迟发性出血率比较,差异无统计学意义(P>0.05)。结论小剂量、短疗程质子泵抑制剂可以有效预防低危ESD术后出血,快速改善再生黏膜组织学成熟度,提高溃疡愈合质量,值得在临床上进一步推广应用。

Objective To explore the efficacy of low-dose,short-term proton pump inhibitors in preventing postoperative bleeding of low-risk endoscopic submucosal dissection(ESD).Methods From January 2019 to January 2021,160 patients who underwent ESD for early gastric cancer or precancerous lesions in our hospital were selected as the research objects,and were randomly divided into two groups by the random number table method,80 cases in each group.In the experimental group,there were 44 males and 36 females,with the age of(59.78±5.76)years old;in the control group,there were 41 males and 39 females,with the age of(60.21±6.05)years old.The patients in the experimental group were given esomeprazole 20 mg bid intravenously after ESD,changed to oral preparations(esomeprazole magnesium enteric-coated capsules,20 mg qd)3 days later,and the treatment continued for 4 weeks.The patients in the control group were given esomeprazole 40 mg bid intravenously after ESD,changed to oral preparations(esomeprazole magnesium enteric-coated capsules,20 mg bid)3 days later,and the treatment continued for 8 weeks.The two groups underwent electronic gastroscopy 4 and 8 weeks after ESD treatment to evaluate the quality of ulcer healing by the histological maturity of regenerative mucosa,and the postoperative bleeding rates of the two groups were compared.Results The excellent rate of histological maturity of regenerative mucosa of the experimental group was significantly higher than that of the control group 4 weeks after the operation[36.25%(29/80)vs.21.25%(17/80)](P<0.05);there was no statistically significant difference in the excellent rate of histological maturity of regenerative mucosa between the two groups 8 weeks after the operation[53.75%(43/80)vs.55.00%(44/80)](P>0.05).The delayed postoperative bleeding rate of the experimental group was significantly lower than that of the control group 4 weeks after the operation[2.50%(2/80)vs.11.25%(9/80)](P<0.05);there was no statistically significant difference in the delayed postoperative bleeding rate between the two groups 8 weeks after the operation(P>0.05).Conclusion Low-dose,short-term proton pump inhibitors can effectively prevent postoperative bleeding of low-risk ESD postoperative bleeding,quickly improve the histological maturity of regenerative mucosa,and improve the quality of ulcer healing,which is worthy of further clinical application.